Medicare AdvantagePrior AuthMedium impact
23-1241m Medical Policies - September 2023
Health Net·CA · Oncology, Pulmonology, Sleep Medicine +6 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net California updated multiple medical policies for September 2023, including new policies for Lantidra cellular therapy and palliative care eligibility, plus significant updates to prior authorization criteria for transplant procedures, sleep studies, radiation therapy, and pain management interventions.
Action Required
Immediately: Review updated prior authorization requirements for donor lymphocyte infusion, sleep studies, intensity-modulated radiotherapy (now covering uterine neoplasms, pancreatic cancer, and stage III non-small cell lung cancer), lung transplantation, pediatric kidney transplant, posterior nerve stimulation, and sacroiliac joint interventions. Update prior authorization workflows and ensure staff are aware of revised medical necessity criteria. Note that ADHD Clinical Practice Guideline and Ambulatory Surgery Center Optimization policies have been retired.